US 7241298 B2
A universal alignment guide for universally positioning an instrument with respect to a bone to facilitate resecting the bone along desired orientations. The alignment guide comprises a spheroidal base and a collar coupled to the base in a manner to allow universal motion of the collar with respect to the base. The base of the alignment guide is attached to a bone anchor implanted in a bone, and the collar is attached to an instrument, such as a resection guide. With respect to a distal femur, the alignment guide facilitates simultaneous positioning and locking of the resection guide in flexion/extension, varus/valgus, internal/external rotation, and proximal/distal orientations.
1. An alignment guide for positioning an instrument with respect to a bone, comprising:
a bone anchor having a first end and a second end, and adapted to be attached to a bone at said first end;
a spheroidal base member mounted on said second end of said bone anchor;
a collar member mounted on said spheroidal base member; and
a resection guide attached to said collar member;
wherein said base member is attached to said second end of said bone anchor; and
said collar member is associated with said base member facilitate universal motion of said collar member with respect to said base member for positioning said resection guide wherein said spheroidal base member has a passage for cooperative assembly with said second end of said bone anchor.
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at least one protrusion on said collar;
at least one channel in said protrusion;
said resection guide containing at least one attachment rod; and
said at least one channel arranged for cooperative assembly with said at least one attachment rod, and
at least one arrestor arranged on said alignment guide to control motion of said resection guide relative to said collar.
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17. A method of positioning an instrument relative to a bone comprising:
inserting a bone anchor having a longitudinal axis into an anterior lateral or medial surface of the distal femur, fixedly coupling a spheroidal base to said bone anchor, said spheroidal base having a bore alignable with said bone anchor longitudinal axis for receiving said bone anchor;
coupling a collar to said spheroidal base in a manner to facilitate universal motion
attaching a resection guide to said collar; and
moving said collar with respect to said base to position said resection guide relative to said bone.
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28. A method for preparing a knee joint surface for placement of a prosthetic implant comprising:
mounting an alignment guide on an anterior lateral or medial surface of a bone adjacent to a knee joint, said alignment guide comprising a spheroidal base and a collar associated with said base in a manner to facilitate universal motion of said collar with respect to said base;
fixing said base with respect to said bone by the insertion of an axially extending bone fastener engaging the bone into a bore in said spheroidal base;
slidably mounting a resection guide on said collar;
moving said resection guide in at least one of proximal/distal, varus/valgus, flexion/extension or internal/external rotation by moving said collar with respect to said base and said resection guide with respect to said collar to a desired position;
locking said resection guide in position; and
resecting said joint surface.
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1. Field of the Invention
The invention relates to methods and instrumentation for use in preparing a bone surface for attachment of a prosthesis. More particularly, the invention relates to methods and instrumentation for aiding in the alignment and positioning of a resection guide relative to bone surfaces, in order to resect the bone surfaces and prepare them for attachment of endoprostheses. A common procedure in which this invention may be employed is knee arthroplasty.
2. Brief Description of the Prior Art
Joint replacement procedures, such as total knee arthroplasty, involve replacement of the load bearing surfaces of bones with artificial components. Proper implantation of these components, or implants, requires detailed measurements of the joint as well as accurate resections of the bone surfaces in preparation for their attachment to their respective components.
As used herein, when referring to bones or other body parts, the term “proximal” means closest to the heart, and the term “distal” means more distant from the heart. When referring to tools and instruments, the term “proximal” means closest to the practitioner, and the term “distal” means distant from the practitioner.
In attempting to duplicate the natural behavior of the joint, replacement components require specific positioning and attachment to the bones of the joint that they are to replace, in accordance with the detailed measurements. Commonly, since the bone-contacting surface of an implant, for example a distal femoral component, has a specific geometry, the bone to which it is to be attached must be accurately resected and shaped to mate with the geometry of the implant and provide the implant's proper alignment in the joint.
Measurement and placement of the distal femoral component, for example, requires determination of the following four orientations prior to implantation: proximal/distal, flexion/extension, varus/valgus, and internal/external rotation.
Various techniques and instruments are known for facilitating making these measurements and then resecting the bone surfaces accordingly. Examples of such are found in published U.S. patent application Ser. Nos. 20020133160, 20020133161, 20020133162 and 20020133163, as well as U.S. patent application Ser. No. 09/974,524, entitled “Methods and Tools for Femoral Resection in Knee Surgery”. These applications teach an alignment guide coupled to a bone anchor that is attached to the distal femur. The alignment guide is also joined to a resection guide via an attachment rod. Orientation and locking of the resection guide is done via three cam locks on the alignment guide. One cam lock is for adjusting and locking varus/valgus orientation, another is for flexion/extension, and a third is for proximal distal orientation of the resection guide relative to the distal femur. This alignment guide is therefore designed for independent locking of three orientation positions of the resection guide. Removal of the resection guide and attachment of further instruments would provide additional positioning capabilities.
Recently, various computerized systems have been introduced to aid the practitioner during different surgical procedures. These systems include multiple video cameras which are deployed above the surgical site and a plurality of dynamic reference frame (DRF) devices, also known as trackers, which are attached to body parts and surgical instruments. The trackers are generally LED devices which are visible to the cameras. Using software designed for a particular surgical procedure, a computer receiving input from the cameras guides the placement of surgical instruments.
Additionally, computer-assisted surgery has been developed which utilizes a tracking system that can relate positions on the patients and/or instruments to stored X-ray, CT scan and MRI data previously obtained for the patient. More recently, image free computer-aided surgery has been utilized where mechanical relationships can be calculated from anatomical reference points such as in joint arthroplasty. These systems are used intra-operatively for performing various surgical procedures, including replacement of artificial joints.
It has been especially useful to utilize trackable medical instruments for use in procedures utilizing computer-assisted image guided or image free medical and surgical navigation systems. Systems using body images are shown in U.S. Pat. Nos. 5,383,454 to Bucholz and 6,021,343 to Foley et al. In general, these image-guided systems use computer stored digital images of a body part obtained, for example, by CT scans taken before surgery, to generate images on a display, such as a CRT monitor screen, during surgery. These images are used in connection with real time information for representing the position of a surgical instrument with respect to the body part. The systems typically include tracking devices such as, for example, a tracker having LEDs and attachable to a surgical instrument as well as a patient's body part, a tracking array used in real time during surgery to track the position of the body part and the instrument via the tracker, and a monitor screen to display images representing the body and the position of the instrument relative to the stored images as the surgical procedure is performed.
An image-free type system is shown in U.S. Pat. No. 6,385,475. Some systems of this type include virtual joint images. In such systems, active or passive marker elements are attached to bones on opposite sides of a joint and a measuring device, such as an optical sensing camera coupled to a data processing system to which signals corresponding to the positioning data of the marker elements is supplied by the optical camera system, is used to correlate the markers on opposite sides of the joint. With a pointer mounted tracker, it is possible to locate various anatomic reference points on the joints to allow the system to position a cutting instrument such as a reamer or saw blade.
The prior art instrumnts used for determining the correct orientations for tibial and femoral resection in total knee arthroplasty, for example, leave room for optimization with respect to their designs, interaction with computer-assisted surgery instrumentation, as well as speed and ease of use.
It is an object of the present invention to provide an instrument which facilitates the determination and setting of numerous desired alignment orientations respective to a bone. With reference to a distal femur, for example, these are referred to as proximal/distal, flexion/extension, varus/valgus, and internal/external rotation. Those skilled in the art will recognize that comparable movements and orientations on other bone segments, although termed differently, will be similarly facilitated by the present invention.
It is also an object of the present invention to provide an instrument which facilitates the determination and setting of numerous desired orientations simultaneously, rather than sequentially.
It is yet another object of the present invention to provide an improved instrument design that offers greater speed and ease of use.
These and other objects are achieved by the present invention, which is a universal alignment guide for positioning an instrument with respect to a bone.
In the preferred embodiment, the alignment guide is comprised of a spheroidal base and a collar associated with the base in such manner as to facilitate universal motion of the collar with respect to the base. The base is attached to one end of a bone anchor, the bone anchor being set in a bone at its other end. It is noted that the spheroidal base need not be a full sphere, but only enough of a structure to facilitate the universal motion between the collar and the base, as described herein.
In a second embodiment, the collar, rather than the base, is associated with the bone anchor, leaving the base free to move with respect to the collar. With regard to this embodiment, the description of features of other embodiments, as well as the preferred embodiment, may be similarly incorporated into this second embodiment.
It is noted that the bone anchor may be set at any convenient location on any desired bone. For example, the anchor may be set medially or laterally on the distal femur, or on the humeral head. Advantageously, the anchor is positioned so as to facilitate unencumbered positioning and use of the alignment guide and resection guide, as well as any other instruments, trial components, and implants. Also advantageously, the anchor is set three inches from the end of the distal femur. Additionally, the anchor may be attached to the bone in a variety of ways commonly known to those skilled in the art. Some non-limiting examples of attachment are screwing, clamping or cementing the anchor to the bone.
In the preferred embodiment, a resection guide may be attached to the freely movable collar, for universal positioning with respect to the bone. Alternatively, in the second embodiment, the resection guide may be attached to the freely movable base for the same purpose. As commonly known to those skilled in the art, the resection guide is used to facilitate cutting the bone at desired orientations. The attachment and manipulation of other cutting guides and instruments, however, is also envisioned, and is encompassed generally by reference to the term resection guide, as used herein.
In the preferred embodiment, the collar is advantageously assembled from a top and bottom portion. These two portions are positioned so as to encapsulate the spheroidal base, and are then joined together. The preferred method of joining the two portions together is by shielded metal arc welding (SMAW). It is recognized, however, that there are many other methods, techniques and designs to facilitate joining the two portions of the collar together.
In the preferred embodiment, the base contains a through bore, or passage, for cooperative assembly with one end of the bone anchor. In a third embodiment, not shown, the passage terminates inside the base, rather than penetrating all the way through. In the second embodiment, the collar contains at least one passage for cooperative assembly with one end of the bone anchor.
In the preferred embodiment, once the bone anchor is inserted into the passage in the base, in order to lock the base against the bone anchor, a threaded slot in the base, together with an accompanying fixator, or set screw, are provided. The slot intersects with the passage, and the set screw is forwarded through the slot until it abuts the bone anchor, thus stabilizing and locking the base in position against the bone anchor. An opening, or window, is further provided in the collar of the alignment guide to allow additional access to the set screw. In the second embodiment, this is similarly accomplished, except with the bone anchor being inserted into a passage in the collar.
In the preferred embodiment, on the portion of the base facing the bone, is a flattened surface to enable closer positioning of the base, and consequently, the alignment guide, to the bone.
Further in the preferred embodiment, the collar contains a motion governor which facilitates locking the collar against the base once the desired position of the collar relative to the bone has been selected. The motion governor is made up of an actuator, or threaded knob, and a threaded aperture in the collar. Preferably, the threaded aperture is located in a protrusion on the collar. Among other advantages, the protrusion provides added surface area to the aperture for increased threaded engagement between the knob and collar. The second embodiment contains similar structure.
In the preferred embodiment, locking of the collar against the base is accomplished in the same manner as locking the base against the bone anchor. That is, the threaded knob is advanced through the aperture in the collar until the knob abuts the base and locks the collar in position against the base.
In the preferred embodiment, the alignment guide further contains a resection guide. The resection guide has two attachment rods which slidably engage two channels in the collar. It is possible, however, that the resection guide, or any other attaching instrument, may be coupled to the alignment guide via at least one area of contact.
Preferably, the channels and rods of the resection guide have rounded circumferences, however, any geometry may be implemented. Also preferably, the channels are located in protrusions on the collar, which provide added material to the collar to support assembly and interaction with the resection guide.
In the preferred embodiment, each of thee protrusions on the collar also contains at least two threaded bores. On each protrusion, the bores are oriented at ninety degrees to each other as well as to the channel. Each bore accepts an arrestor, or threaded knob. It is also envisioned, however, that a protrusion may have at least one bore, and that the angularity of a bore relative to either another bore, or to a channel, may be other than ninety degrees.
In the preferred embodiment, upon insertion of both attachment rods of the resection guide into the respective channels in the collar, each one of two knobs, when advanced through a selected bore on oppositely oriented protrusions of the collar, is used to lock the resection guide in place. It is noted that having two bores oriented at ninety degrees to each other on one protrusion, advantageously provides an additional angle of insertion of the knobs for locking the attachment rods of the resection guide against the collar.
The preferred method of using the present invention includes attaching a bone anchor to a bone such as a femur or humerus, coupling the base of the alignment guide to the bone anchor, locking the base against the anchor to prevent it's movement with respect to the bone, attaching a resection guide to the collar, orienting the resection guide relative to the bone by movement of the collar relative to the bone, and fixing the desired position of the resection guide by locking the collar against the base with an actuator and locking the resection guide in the collar with arrestors.
With reference to the distal femur, and without regard to the particular instrument attached to the alignment guide, in the preferred embodiment, the orientations of flexion/extension, varus/valgus and internal/external rotation are accomplished by moving the collar relative to the base. Proximal/distal orientation is accomplished by moving the resection guide relative to the collar.
It is preferable to first set all of the desired orientations and then lock the collar and resection guide in place. However, locking the collar and resection guide sequentially is also possible.
The present invention may be used by itself, or in conjunction with other navigational equipment such as a computer-aided surgery system using an optical tracking system mounted on the instrument, which aids in the location and positioning of various resection planes relative to a bone.
In the drawings, wherein similar reference characters denote similar elements throughout the several view:
FIG. 7. is a perspective view of the alignment guide, lateral resection guide, and tracker in a lateral orientation with respect to the knee joint.
FIG. 8. is a perspective view of a set of variously sized lateral cutting blocks.
Initially, bone anchor 60, having a first end 61 and a second end 62, is implanted at its first end 61 into the anterior portion of distal femur 70. In the preferred embodiment, the configuration of second end 62 of bone anchor 60 includes a cross-bar 63 which engages a slot 21 a in passage 21 of spheroidal base 20, and facilitates proper mating with alignment guide 10. Additionally, cross-bar 63 serves as an attachment point for a tracker 300, as shown in FIG. 7. It is recognized that various other designs of second end 62 of bone anchor 60 may suffice for these purposes.
In the preferred embodiment, base 20 has passage, or bore, 21 into which bone anchor 60 is inserted. In an alternate embodiment, not shown, passage 21 may terminate inside base 20. In the preferred embodiment, passage 21 has a cross-slot 21 a such that it will accept and mate with cross-bar 63 of second end 62 of bone anchor 60. Base 20 further has a threaded slot 23 which is oriented on base 20 so that it intersects passage 21. Once the second end 62 of bone anchor 60 is inserted into passage 21 in base 20 of alignment guide 10, a fixator, or set screw 24, is threaded into slot 23 and advanced until it abuts bone anchor 61 in passage 21. Tightening of set screw 24 against bone anchor 60, secures base 20 against bone anchor 60.
In the preferred embodiment, alignment guide 10 also has a collar 30 that partially encapsulates base 20, thereby facilitating universal motion of collar 30 with respect to base 20. As seen in
As mentioned above, protrusions 35 and 36 contain channels 45 and 46 that penetrate protrusions 35 and 36 respectively. These channels 45, 46 are designed for engagement with resection guide 50.
Resection guide 50 has first and second attachment rods 51 and 52 which slidably engage respective channels 45 and 46 in protrusions 35 and 36 of collar 30. It is recognized that although the cross-sections of channels 45, 46 and rods 51, 52 are round, any interactive shapes and configurations are possible. Resection guide 50 also includes rotatable pin guides 50 a and 50 b to facilitate joining other surgical instruments to resection guide 50, as well as attachment points 50 c and 50 d for use in connecting trackers, such as tracker 300 depicted in
Protrusions 34, 35 and 36 provide added material to the collar for interaction with knobs 40, 41 and 42 of resection guide 50. However, it is also envisioned that collar 30 may be made without protrusions by uniformly having more circumferential material to support and interact with knobs 40, 41, and 42 and resection guide 50.
In operation, once rods 51, 52 of resection guide 50 are inserted into their respective channels 45, 46, knobs 41 and 42 are used to lock resection guide 50 in place. This is done, for example, by threadably forwarding knob 41 through bore 38 until knob 41 abuts rod 51 of resection guide 50 within protrusion 35, thereby locking resection guide 50 in place with respect to collar 30. Although it is recognized that one knob will lock resection guide 50 in place, preferably, a second knob, 42 can also be threadably advanced through bore 38 until it abuts rod 52 in channel 46, thereby more securely locking resection guide 50 to collar 30 of alignment guide 10. It is further recognized that resection guide 50 may have only one attachment rod, and be attached and locked to collar 30 via only that rod.
The components of alignment guide 10 are preferably made from surgical grade materials. In the preferred embodiment, base 20, collar 30, set screw 24 as well as knob heads 40 a, 41 a, and 42 a and knob shafts 40 b, 41 b, and 42 b are made from surgical grade stainless steel. Other surgical grade materials, as well as disposable materials are, of course, also envisioned.
In conjunction with the preferred embodiment depicted in
First, bone anchor 60 is implanted into the anterior surface of distal femur 70 approximately three inches away from the end of the distal femur. As mentioned previously, advantageously, the anchor is positioned so as to facilitate unencumbered positioning and use of the alignment guide and resection guide, as well as any other instruments, trial components, and implants associated with the desired surgical procedure. It is also recognized, and depicted in
Next, according to the preferred embodiment, alignment guide 10 is placed onto bone anchor 60 by means of aligning cross-bar 63 with slot 64, and sliding bone anchor 60 through passage 21 in base 20. Alignment guide 10 is then locked in position with respect to bone anchor 60 by threadably inserting and advancing a set screw 24 through slot 23 in base 20, until set screw 24 abuts bone anchor 60 to the extent necessary to prevent movement of base 20 relative to bone anchor 60. At this point, collar 30 is free to rotate about base 20.
Resection guide 50 is then attached to collar 30 by inserting attachment rods 51 and 52 into respective channels 45 and 46 in collar 30. Resection guide 50 may then be positioned relative to distal femur 70. As explained above, flexion/extension, varus/valgus and internal/external rotation are attributable to the movement of collar 30 relative to base 20. Proximal/distal orientation is attributable to movement of resection guide 50 relative to collar 30. To simultaneously fix the flexion/extension, varus/valgus and internal/external rotation positions of resection guide 50, with reference to
In the second embodiment, resection guide 250, comparable to resection guide 50 of the preferred embodiment, is attached to the base 220 of alignment guide 200 via at least one attachment rod 255. Attachment rod 255 is fixedly joined to base 220 and slidably engaged by resection guide 250.
Flexion/extension, varus/valgus and internal/external rotation are attributable to the movement of base 220 within collar 230. In order to fix, or lock, these orientations, actuator 40 is threadably advanced through collar 230 in the same manner as in the preferred embodiment, until it abuts base 220 and locks it in position relative to collar 230.
Proximal/distal orientation is attributable to movement of resection guide 250 along attachment rod 255, relative to base 220. It is further recognized, however, that the single rod attachment to resection guide 250 also facilitates internal/external rotation. In order to lock resection guide 250 against rod 255, there is provided an arrestor 254 that threadably engages resection guide 250, and can be advanced until it abuts rod 255 and locks it into place.
With the exception of accounting for the above-enumerated differences in structure in the second embodiment, the procedure for using resection guide 200 is similar to that of the preferred embodiment. Bone anchor 60 is implanted into a bone, such as distal femur 70, in a variety of orientations such as either anteriorly or laterally. Alignment guide 200 is then set upon bone anchor 60 and locked in position by threadably inserting and advancing fixator 224 in slot 223 in collar 230 until fixator 224 abuts bone anchor 60 to the extent necessary to prevent movement of collar 230 relative to bone anchor 60. At this point, base 220 is free to rotate within collar 230. Then resection guide 250 is slidably set upon attachment rod 225.
To simultaneously fix the flexion/extension, varus/valgus and internal/external rotation positions of resection guide 250, actuator 40 is threadably advanced through collar 230 until it sufficiently abuts base 220 to lock collar 230 in position relative to base 220. To then lock the proximal/distal position of resection guide 250, arrestor 254 is threadably advanced through resection guide 250 until it abut rod 255 and locks it in place relative to base 220. Once the flexion/extension, varus/valgus, internal/external rotation, and proximal/distal orientations of resection guide 250 relative to distal femur 70 are fixed, further procedures known to those of ordinary skill in the art can be carried out in the furtherance of resecting distal femur 70.
As opposed to resection guide 50, however, lateral resection guide 100 is intended for use in the lateral approach to knee replacement surgery, as depicted in FIG. 7. Specifically, this involves inserting bone anchor 60 into the lateral surface 74 of a bone such as the distal femur 70, as opposed to the anterior surface 72 as in the preferred and second embodiments. Notably, it is advantageous to insert bone anchor 60 approximately three inches from the end of the distal femur. Then, coupling alignment guide 10 or 200 to bone anchor 60, attaching lateral resection guide 100 to the alignment guide, and advantageously aligning it to the knee joint as known to those skilled in the art.
Lateral resection guide 100 provides five cutting guide surfaces to facilitate preparing the knee joint for replacement components. Specifically, lateral cutting guide 100 has an anterior cutting guide surface 130, an anterior chamfer cutting guide surface 140, a distal cutting guide surface 150, a posterior chamfer cutting guide surface 160, and a posterior cutting guide surface 170. Additionally, it has features 120, such as holes and slots, to facilitate marking its position and pinning it to bone 70. Because of various anatomical sizes of bones, lateral resection guide 100 may be provided in a variety of sizes, as shown in FIG. 8.
Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.